Covid action plan. An action plan to break the second wave

Without going into the blame game (though all, including the Central and State governments, the Election Commission, political parties and the general public, are responsible in varying degrees), several steps need to be taken at the earliest to tackle the second wave of the Covid pandemic that has hit us like a Tsunami and catching us unprepared.

One, vaccination, by creating mass immunity, is the only longer-term solution to stem this tide. Given the insufficient supply of vaccines, we need to break up the 18-44 age group into several sub-groups like 35-44, 25-34, 18-24 and vaccinate the sub-groups one by one, instead of throwing the door open for everybody at one go.

This would minimise chaos, harassment, physical hardship and chances of further spread from overcrowded vaccine centres. Also, don’t insist on pre-registration through the Co-Win portal. There are millions of non-tech savvy people without access to computers/smartphones and the required internet bandwidth. Allow walk-in vaccination, just as was the case for the 45-59 age group which worked reasonably well without excessive overcrowding.

Central procurement

Two, the Centre must procure all vaccines from manufacturers at cost plus a reasonable profit margin (after adjustment of any state funding to the manufacturers at the research or subsequent stages) and then distribute to State governments which, in turn, would supply to all hospitals (State and private).

Use the ongoing supply chain networks and improve upon them, instead of asking State governments and private hospitals to buy directly from the manufacturers by creating their own supply chains. No sale of vaccines in free market is to be allowed which would inevitably lead to black-marketing. Under this kind of national health emergency with acute shortages of vaccines, oxygen and essential drugs, free market is not the solution. Leaving the situation to competition between States and different hospitals to procure the supplies would only lead to price gouging by manufacturers and would be highly inequitable.

Uniform vaccine price

Three, there should be uniform price of vaccines for all citizens. As in the case of the 45-59 age group, it can be free at government outlets for ‘the poor’ and at an uniform price at private hospitals like, say, ₹250 per dose. The subsidy implied in this low price has to be paid by the Centre, which has much more financial resources than the State governments. This is a national emergency, not a State-level one. In terms of economic theory, if there is ever a case for subsidising a service on the ground of positive externalities (since vaccinating one person benefits a lot more people by breaking the chain of transmission), this is one.

Four, given the enormity of this national health emergency and the need to augment manifold the supply of vaccines at the earliest, the Centre should immediately invoke the compulsory licensing clause allowed by the WTO and permit other drug manufacturers to mak the patented vaccines. To be fair to the innovating drug companies, the government may compensate the firms holding the patents by reimbursing their cost of R&D.

Five, increasing hospital beds with oxygen and ICU facilities is not enough. The most important bottleneck is the shortage of doctors, and even more so of nurses and paramedic staff. Without constant monitoring of oxygen levels and other vital parameters, no effective treatment can be provided to Covid patients. Hence, medical students who have finished their courses and are waiting to sit for the final exams and the nursing students in the final year of studies should be deployed as doctors and nurses for Covid duty in hospitals for a year or so.

This extraordinary service by them should earn them credit to qualify as full-fledged doctors and nurses, with appropriate additional coursework/training, after their duty year ends. This is a war-like situation, needing war-time emergency measures.

Six, doctors should refrain from prescribing Remdesivir or such emergency medicines to patients (in home quarantine) just because the patient wants to keep it as a backup. According to medical experts, Remdesivir is not a cure. Only oxygen and steroids are. Remdesivir also produces adverse side-effects and should be used only under very specific conditions and strict medical supervision.

If at all prescribed, the doctor or the hospital will have to provide the medicine. Asking the patient’s family to procure it from the market is leading to acute shortage, hoarding, black-marketing, frantic running around and huge financial burden (a Remdesivir black-markets for upwards of ₹40,000 a vial) for the already stressed family members.

Seven, immediate vaccination of staff at cremation and burial grounds is urgently needed. Apart from handling inhuman workloads, these people are being exposed to high viral loads and are potential sources of further spread of the disease.

Eight, dissemination of proper information regarding the availability of hospital beds, oxygen cylinders, concentrators and other essential medical supplies are needed as inadequate and often conflicting information is leading to panic and huge harassment of patients and their overstressed relatives. There should be one official portal providing all necessary information truthfully.

Nine, voluntary organisations, including local clubs/housing societies (preferably under the supervision/coordination of the local police station whose telephone number can be called any time to convey medical emergencies), should keep a minimum stock of oximeters and oxygen cylinders, for the joint benefit of the locality, as no centralised agency would be able to assess the local needs at a sufficiently granular level and respond at the earliest.

Finally, this is not the time for political one-upmanship. All resources from whatever sources (domestic or foreign) should be pooled together and used to mitigate the suffering of the nation, with no discretionary powers to the Prime Minister or Chief Ministers to choose favourites or win political brownie points.

The writer is a former Professor of Economics, IIM, Calcutta and Cornell University, USA

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